Reflective Assessment: Improving Nursing Care in Surgical Ward Setting

This reflective assessment details a registered nurse's experience in a surgical ward, specifically focusing on the care of a post-operative renal transplant patient, Mr. Rashid. The nurse reflects on a situation where the patient developed hyperthermia and identifies the failure of strict aseptic technique as the root cause. The assessment follows Gibbs' reflective cycle, detailing the nurse's feelings of worry and guilt, the evaluation of the situation, and the analysis of the incident. The nurse's initial belief that strict aseptic technique was not mandatory during busy schedules is challenged, leading to a change in attitude and the implementation of stricter protocols. The nurse emphasizes the importance of handwashing and adherence to hospital policies. The assessment concludes with an action plan for future scenarios, highlighting the need for continuous monitoring, evidence-based practice, and a commitment to preventing medical errors. The nurse references several studies to support the analysis and conclusions, emphasizing the importance of aseptic technique in preventing post-operative infections and improving patient outcomes. The experience serves as a valuable learning opportunity, changing the nurse's perspective on the priority of medication administration versus aseptic technique.

Personal and professional assessment
Situation
I am a registered nurse posted in the surgical ward. I was assigned to the patient named Mr.
Rashid. He is 45 years old admitted with signs and symptoms of impaired kidney function.
He was posted for renal transplantation. He underwent the surgery. I received him after the
surgery. I was assigned to care for Rashid post-operatively. I was implementing the post-
operative procedures and surgical wound dressing to ensure quality nursing care for him. I
was assigned to him for a week. On the third post –the operative day he had increased body
temperature (99F) and related symptoms. I gave him antipyretic as per the physician’s advice
and implemented non-pharmacological interventions to maintain normal body temperature
for him.
On the fourth postoperative day, his temperature increased to 100F despite the effective
nursing interventions. I wanted to locate the cause for the infection and increased body
temperature. I analyzed the procedures and protocols implemented and found that the failure
of a strict aseptic technique is the cause. After finding the cause for the hyperthermia of the
patient I implemented a strict aseptic technique to ensure quality nursing care. This reflective
assessment aids in analyzing the situation and find the cause for the clinical issue. In this
assessment, I am reflecting on the nursing care of postoperative patients with infection and
hyperthermia. According to Potter 2, the structured format used in the study is the Gipps
reflection cycle.
Feelings
When the patient developed hyperthermia I was worried about his condition as he had the
renal transplant recently and the possibility of transplant failure is high in infection. Before
the incident I believed that the strict aseptic technique is not mandatory during busy
schedules and giving medication was the high priority nursing care in the action of preventing

infection. Other health care professionals were worried about the condition of the patient.
After implementing the strict aseptic technique the patient’s temperature was normalized. The
health care professional working with me also understood the importance of strict aseptic
technique.When I went through the situation, I was worried about the condition of the patient
and wanted to normalize the increased temperature. Based on the study of Pegram 4, I
wanted to provide holistic and quality nursing care for the patient. When I recall the situation
now, I think that the simple procedures and protocols in patient care can make a vast
difference in the quality of care. Hand washing before and after the nursing care is the
protocol which can make unimaginable changes in the patient outcome.
Evaluation
Evaluation of the situation improves clinical knowledge through learning from the error
process. Good about the experience is learning. As a registered nurse I was having a wrong
belief and attitude about the hand washing and aseptic technique. My high priority care for
the patient was the administration of medication before the experience. Bad about the
experience is the suffering of the patient. As per the study of Dhakal 1, the patient suffered
from pain and fever. Recovery from the infection and fever was difficult and I was feeling
guilty about seeing the affliction of the patient. The learning process went well. As the cause
for the infection was identified on the third day of the fever and implemented aseptic
technique. In this situation, the recovery from infection was slow as the patient was on
steroids and had renal transplant recently. Patient food intake was significantly affected due
to pain and fever which was the issue that didn’t go well in the situation. I and other people
contribute to the situation as the experience thought our new lesson on the importance of
handwashing and aseptic technique.
Analysis

In the incident, things went well as the issue was solved before the clinical deterioration of
the patient. On the 3rd day, the patient developed infection and fever. On the 4th day, the
problem was identified. But the patient had a bad experience immediately after the surgery.
His recovery process did not go well. According to Rowley et al. 5, the situation is an
effective learning experience for me and other health care professionals. This situation has
improved my clinical knowledge. I understood that my hands are carrying the micro-
organisms. Proper hand washing before and after patient care can prevent the transmission of
infection. I have analyzed the situation with the support of evidence-based literature to
improve my clinical knowledge and skill.
Conclusion
This situation has changed my belief and attitude about hand washing. I used to prioritize
medication administration as an essential nursing duty. This incident had changed my attitude
regarding that. I have learned the importance of aseptic technique and hand washing. I shared
the incident with my fellow workers and other health care professionals. This incident has
changed the attitude and beliefs of many health care workers. I need to develop an attitude of
valuing the policies, standards, and protocols implemented by the hospital management and
department of health. Based on the study done by Rowley et al. 5, I developed the skill of
implementing the aseptic technique as part of nursing care. As a surgical nurse, I could have
prevented the post-operative infection for the patient. Prevention of infection is considered to
be the high priority need for post-operative patients.
Action plan
If I have to go through the same incident I will monitor the vital signs of the patient
continually and implement a strict aseptic technique to prevent infection. I will study each
patient to learn and to prevent medical errors. I will develop the required skills by updating
my knowledge through evidence-based literature According to the assessment of Pickering

4, I will learn from errors to prevent the repetition of errors and improve the quality of
patient care. When I come through the same situation again I will follow proper handwashing
techniques. I will follow the standards, policies, and protocols of the hospital management
after the detailed study of the issue using the evidence-based literature review.

References
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